Published on June 17, 2020
Chronic lymphocytic leukemia (CLL) patients should begin resuming regular in-person treatment now that the spread of the novel coronavirus has slowed and measures are in place to reduce exposure, said Dr. John Allan, who specializes in hematology-oncology at Weill Cornell Medicine/New York-Presbyterian Hospital in New York City.
“I do believe that the pendulum is swinging back to where deferring care and deferring initiation of treatments is going to be detrimental,” Dr. Allan told Patient Power Co-Founder Andrew Schorr in a recent Answers Now program. “…Even my CLL patients, it's getting to a point where I need to see the patient in-person. I need to feel those lymph nodes, because our patients aren't always the best at feeling them, or they don't want to, and they don't know how to find and get really deep into the lymph node,” he added. “And maybe we don't know what that white count has done in the past three to four months where, really, we would have had that information now.”
Dr. Allan said that Weill Cornell’s clinics were basically shut down during the height of the pandemic. New York City was the epicenter of the virus, and New York state has the most deaths in the country from COVID-19, the disease caused by the novel coronavirus.
He said treatment was limited to those patients with curative illnesses such as diffuse large B-cell lymphoma, an aggressive type of non-Hodgkin lymphoma where stopping treatment would be life-threatening.
“We are seeing now that we have gotten through the curve, we have flattened the curve,” he said. “And, in fact, hospitalizations are down. I think the deaths are way down. The patients in ICUs on ventilators are way down from this. And so we've done a really good job at identifying and understanding that preventative measures go a long, long way.”
Dr. Allan acknowledged some treatments have given him pause, such as venetoclax (Venclexta)-based therapies, which require frequent office visits. He also is a bit hesitant about resuming anti-CD20 infusions, such as rituximab (Rituxan), or obinutuzumab (Gazyva), though he said some of his patients continued to receive the therapies as part of a clinical trial.
“I think it's patient-specific,” he said. “How much risk aversion do the doctor and the patient have? Which approach makes sense for them? But I think either way you want to go, we can do it safely. And we have yet to show any data that anti-CD20 use puts you at a higher risk for severe complications or anything along these lines. And I think that will come out with time.”
Dr. Philip Thompson, a hematologist/oncologist at The University of Texas MD Anderson Cancer Center in Houston, who was also part of the Patient Power panel, agreed. He said patients are far more likely to get COVID-19 from eating at a local restaurant than coming to the cancer-specific hospital for treatment.
“I think when you've got one treatment which is clearly the best option for a patient, you should do that,” he said. “If you have several options where you're not really 100 percent clear what the best choice would be, and you could make an argument either way, then things like how often does the patient have to come to the hospital may weigh into that.
“I think that still, when you have cancer, if you need treatment, the most important thing is to treat the cancer the best that you can rather than worrying about theoretical risk of contracting the virus.”
Patient Power advocate Jeff Folloder, the lead administrator for CLL Support Group on Facebook, who also participated in the program, said anxiety is high among the group’s 6,000-plus members, mainly because of differing guidance from governments on whether to continue treatment.
“So a lot of people are, frankly, scratching their heads and trying to figure this out on their own,” Folloder said. “And I'm not sure that they've done a whole lot to calm themselves down, because they don't know what the real best path is right now.”
Folloder was diagnosed with CLL ten years ago and was put into “watch and wait” mode. He participated in a clinical trial at MD Anderson Cancer Center. He was in remission for six-and-a-half years, relapsed and went back into watch and wait. His CLL is advancing and he may need treatment again.
He said he approaches treatment like a “classic risk manager.” What are the things that are important and critical right now and the impact of deferring treatment? Monitoring his CLL advancement is a priority.
“I'm not going to put it off, because it's important to see where my numbers are,” he said. “It's important for the doctor to check my lymph nodes. It's important to see if my spleen is getting large…So I'm going to rely on MD Anderson, and I'm going to rely on the fact that the hospital has set up safety protocols to maximize my safety for when I need to get it done.”
Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.
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